Abstract: :
Purpose: Early detection and treatment of ophthalmic conditionscausing amblyopia is essential to optimize normal visual acuityand binocular development in preschool children. Practice guidelinesestablished by the American Academy of Pediatrics and AmericanAcademy of Family Physicians recommend preschool vision screeningbe a part of routine health care. However, only 21% of preschoolershave their vision screened.1 We conducted a survey to solicitvision screening practice patterns for 3- and 4-year-old childrenby primary care physicians (PCPs) in West Virginia (WV).Methods:With institutional review board approval, 226 pediatriciansand 633 family physicians (FPs) in WV were anonymously senta questionnaire soliciting their current practice patterns forpreschool vision screening.Results: 30 pediatricians (13%)and 46 family physicians (7%) responded. These respondents represent55% of the counties in WV. 77% (23/30) of responding pediatriciansand 67% (30/45) of responding FPs screen preschoolers for visionand eye disorders. Overall, PCPs who test visual acuity estimatethat they can comfortably test 36% of 3-year-old children and64% of 4-year old children. Most respondents (93% or 39/42)list poor patient cooperation as the most common reason theyare uncomfortable screening this age group. Lack of office time(17% or 7/42) and insufficient training (12% or 5/42) were alsocited as reasons for discomfort when screening. The "Sailboat"kindergarten symbol chart was used most commonly by PCPs (52%or 31/60). More than half of the respondents (59% or 29/49)usea 20' testing distance. Licensed practical nurses (56% or 34/61)typically perform preschool vision screening. Less than halfof respondents (37% or 20/54) bill for the service. When billingdoes occur, many (55% or 12/22) use ICD-9 Code 99173. Reimbursementfrom third party payers ranges from $6 to $20 per patient.Conclusions: Although specialty practice guidelines recommendpreschool vision screening, many PCPs in WV are uncomfortableproviding this service. Poor patient cooperation, especiallywith 3-year-old children, is the most frequently cited reasonfor this discomfort. Many PCPs appear to be unaware of currentmethods for preschool vision screening and would like bettertraining in this area. Improving education, training, and accessto appropriate vision screening methods, as well as enhancingreimbursement, may increase preschool vision screening amongPCPs. 1Ehrlich, M I, Reinecke, R D, Simons, K: Preschool visionscreening for amblyopia and strabismus. Programs, methods, guidelines,1983. Survey of Ophthalmology, 28:145-163, 1983.